Healthcare Provider Details

I. General information

NPI: 1205191228
Provider Name (Legal Business Name): DAWN NWACHUKWU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2012
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6910 BOWERS RD STE G
FREDERICK MD
21702-3614
US

IV. Provider business mailing address

6910 BOWERS RD STE G
FREDERICK MD
21702-3614
US

V. Phone/Fax

Practice location:
  • Phone: 410-864-5693
  • Fax: 346-483-8197
Mailing address:
  • Phone: 410-864-5693
  • Fax: 346-483-8197

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR230948
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: